Engaging patients in health care redesign improves outcomes

IMAGE: Engaging patients in the redesign of health care services can lead to reduced hospital admissions and more efficient and effective health care, a study led by Dr. Yvonne Bombard suggests.
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Credit: St. Michael's Hospital

TORONTO, July 25, 2018 - Engaging patients in the redesign of health care services can lead to reduced hospital admissions and more efficient and effective health care, a study led by a St. Michael's Hospital researcher suggests.

In their study, Engaging Patients to Improve Quality of Care: A Systematic Review, published today in Implementation Science, lead authors Dr. Yvonne Bombard and Dr. G. Ross Baker concluded that active engagement of patients can inform education, tools, planning and policy, and enhance health care service delivery and governance.

The review, which examined 48 studies from across the globe that addressed patient participation in the design and delivery of health care services, further concluded that higher levels of patient engagement were associated with efforts to develop higher level system outcomes for health care, including improved quality of care, governance and service delivery.

"We looked at all the international literature across all care settings, and we found that the more patients were engaged as partners and co-designers, the higher the level of outcomes," said Dr. Bombard, a scientist at the Li Ka Shing Knowledge Institute at St. Michael's Hospital. "There are different levels of engagement. If patients were just consulted, often what we saw in terms of outputs were products like patient information kits. Yet active involvement of patients as partners in design was linked to more substantial outcomes like designing new delivery systems, adding support systems like a mental health advocate, all the way up to creating new governance documents and policies at the top echelons of the hospital."

Dr. Baker, professor and program lead, quality improvement and patient safety, at the University of Toronto's Institute of Health Policy, Management and Evaluation, pointed out that higher levels of engagement require additional investments in training and support that would only be appropriate for larger projects.

"If you really want to focus on redesigning care, you have to bring in patients in a much more active way," he said. "The key message is that there are successful examples of people who have engaged patients to do broad scale redesign, and we should learn from the strategies they've used. And there's more research needed to detail what patient engagement strategies are suitable for what kinds of projects."

Some of those strategies include providing appropriate training for higher-level involvement--not just for patients but for providers as well -- and being flexible and respectful of patients' time and experiences.

"Patients have a unique experience that gives them a different view on what happens in hospitals and other health services, and their insights can be helpful in identifying duplication, waste, failure to coordinate and other issues" said Dr. Baker. "Providers see the care that they're directly engaged in, but the patient sees all the care."

"Hospitals often do this on some level, but sometimes it's done in an ad hoc fashion," Dr. Bombard said. "I think that does a disservice to the science of patient engagement, and over time it might start to create distrust among patients. We hope this work advances the science and methodology of patient engagement so that we're sure we're doing it effectively, for the intended purposes ."

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About St. Michael's Hospital

St. Michael's Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital's recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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